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Heart 1998;79:599-604 ( June )
a Department of Cardiology, Royal Infirmary of Edinburgh,
Edinburgh, UK, b Regional Infection Unit, City Hospital, Edinburgh, UK, c Department of Cardiological Sciences, St
George's Hospital, London, UK, d Division of
Cardiology, Institute of Clinical Medicine, University of Padua, Padua,
Italy
Correspondence to: Dr P F Currie, Department of Cardiology, 1 Lauriston Place, Royal Infirmary, Edinburgh EH3 9YW, UK.
Accepted for publication 16 February 1998
Objective
To assess the frequency of circulating
cardiac specific autoantibodies in HIV positive patients with and
without echocardiographic evidence of left ventricular dysfunction.
Subjects74 HIV positive patients including 28 with echocardiographic evidence of heart muscle disease, 52 HIV
negative people at low risk of HIV infection, and 14 HIV negative drug
users who had all undergone non-invasive cardiac assessment were
studied along with a group of 200 healthy blood donors.
ResultsCardiac autoantibodies detected by
indirect immunofluorescence (serum dilution 1/10) were more common in
the HIV positive patients (15%), particularly the HIV heart muscle
disease group (21%), than in HIV negative controls (3.5%)
(both p < 0.001). By ELISA (dilution 1/320), abnormal
anti-
myosin autoantibody concentrations were found more often in
HIV patients with heart muscle disease (43%) than in HIV positive
patients with normal hearts (19%) or in HIV negative controls (3%)
(p < 0.05 and p < 0.001, respectively). Anti- myosin
autoantibody concentrations were greater in HIV positive patients than
in HIV negative controls, regardless of cardiac status ((mean SD) 0.253 (0.155) v 0.170 (0.076); p = 0.003). In particular the
mean antibody concentration was higher in the HIV heart muscle disease
patients (0.291 (0.160) v 0.170 (0.076); p = 0.001) than
in HIV negative controls. On follow up, six subjects with normal
echocardiograms but raised autoantibody concentrations had died after a
median of 298 days, three with left ventricular abnormalities at
necropsy. This compared with a median survival of 536 days for 21 HIV
positive patients with normal cardiological and immunological results.
ConclusionsThere is an increased frequency of
circulating cardiac specific autoantibodies in HIV positive
individuals, particularly those with heart muscle disease. The data
support a role for cardiac autoimmunity in the pathogenesis of HIV
related heart muscle disease, and suggest that cardiac autoantibodies
may be markers of the development of left ventricular dysfunction
in HIV positive patients with normal hearts.
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